​BOARD CERTIFICATIONS

Internal medicine

Nephrology

“I was amazed at the capabilities that were available in Casper. I have been in major metropolitan areas my entire career — nowhere with less than 3 million people. Wyoming Medical Center provides more services than the typical medical centers that I had experienced in the military or moonlighting in the civilian community,” said Dr. Sawyers.

“I can provide the same medical care offered in a big city medical center and still live in a friendly small town community only eight miles from a mountain. It seemed like the best of both worlds.”

Dr. Sawyers, who is board certified in nephrology and internal medicine, recently joined Wyoming Nephrology in Casper. In this interview, he talks about caring for the country’s V.I.P.s and why treatment advancements in kidney care are a little slow in coming.

Where did you grow up, and how did you become interested in medicine?

I was a Navy brat, so I grew up all over. However when my father retired, he moved us from Hawaii to Kansas. After getting a taste of the world, I wasn’t interested in staying, so I joined the Navy after graduating from high school.

I attended the United States Naval Academy, but was delayed a year because the week before I was supposed to start, I was working for a roofing company and fell 30 feet onto concrete, breaking my back and most of the bones in my legs. I spent a year in rehab seeing dozens of different physicians, and that is how I was initially exposed to, and became interested in, medicine. I was one of the “Top Gun” generation, so I had planned to be a fighter pilot. But my injuries were a show stopper, so medicine seemed like an acceptable fallback career.

How did you become a naval physician?

The Naval Academy allows 10 officers a year — from a graduating class of 1,000 — to attend medical school, and I was lucky enough to qualify for one of the coveted spots. After graduation, I went to the military equivalent of the Naval Academy, or the West Point for medicine, which is Uniformed Services University in Bethesda, Md. I then went on to complete my training in internal medicine and nephrology.

And you later become a congressional physician. Tell us about that.

Typically when senators or congressmen leave the country on official business, they travel with a physician so they aren’t forced to rely on local medical resources. Finding quality medical care in Paris or Rome may not be a big deal, but when you are traveling in the Gobi desert or sub-Saharan Africa, there are many times when there are no local medical resources.

WYOMING NEPHROLOGY

Wyoming Nephrology serves patients with any stage of kidney disease and its associated conditions.

In my time working for the Office of the Attending Physician of Congress, I was lucky enough to have traveled to 92 different countries. I provided medical care everywhere from the Arctic Circle to Tierra del Fuego at the tip of South America, from the Cape of Good Hope in southern Africa to the Old Silk road on the plateaus of Kyrgyzstan. Our official trips included delegations to Tiananmen Square, Red Square, Tahrir Square, and even Pyongyang in North Korea. I had the opportunity to have dinner with the President of China, coffee with the President of Colombia, and even met Muammar Gaddafi in his ‘desert Bedouin compound’ which was a just air conditioned Barnum & Bailey-style tent in the middle of the Sahara desert.

How do you get chosen for that position?

You have to be good at what you do and able to function in austere medical environments while still providing a first-world level of medical care.

Are VIPs more difficult patients? Are they harder to treat than civilians?

No. Why I excelled in that environment is that I realized early on that VIPs often actually get the worst medical care. Many times, medical personnel are so anxious to please the VIPs, they start bending or breaking the rules and standards of medical care. While such efforts are always well intentioned, many of those rules and standards exist to protect the patient. When you start breaking them for patient convenience, you actually start to practice bad medicine.

I made a point to tell all the VIPs that I was going to treat them in the same manner I would a junior sailor fresh out of boot camp. While I expected a backlash, I found that they uniformly appreciated the gesture.

Why did you specialize in internal medicine and nephrology?

Internal medicine and nephrology seemed to offer the best of both worlds. You have the opportunity to specialize, but you still have the ability to take care of your patient’s basic needs. I did not want to be one of those doctors who was so specialized that they “know everything about nothing” or at the other extreme “know nothing about everything.”

What are some of the treatments or advancements in nephrology that have you excited?

Unfortunately there aren’t many in the field of nephrology. Dialysis is tremendously expensive, over $30 billion per year. As a result, I think some of the funding that might otherwise be spent on research is instead used to treat the consequence of our inability to cure many kidney diseases. That said, every year we do get one step closer to using lab grown or non-human kidneys for transplantation. If we can ever overcome the numerous obstacles, it will be a game changer.

What is the end-goal for dialysis? A kidney transplant?

Ideally, yes. Although patients can live long, productive lives on dialysis. I believe there are many people alive today who have been on dialysis for over 40 years.

How difficult is transplantation for most patients?

First you must be a compliant patient. There is a very limited supply of kidneys, so we do our best to make sure they only go to patients who will live healthy lives and take their immunosuppressant medications as prescribed.

Because kidney transplantation is an elective procedure, we want to make absolutely certain patients go into surgery in optimal condition. As a result, there is a huge list of things that a person waiting for a kidney has to do. Typically, it can take three to six months just for a compliant patient to get on the kidney transplant list. After that, the typical wait might be an additional 3 to 5 years, depending upon blood type and area of the country.

That is alarming. Is there research being done to help dialysis patients?

There are reports of “wearable” kidneys. But anytime you introduce something foreign into your blood stream, you have to overcome the body’s defense system. Our bodies have evolved over millions of years to be able to recognize “self” versus “non-self.” You can take a pig’s kidney and connect it to a patient, and it will make urine for about 10 minutes. Then, the body recognizes it as foreign and immediately attacks it.

We keep thinking that in another few months or years, we will solve this problem, but I have been doing this nearly 20 years and we don’t seem to be any closer than when I started. Eventually, through the use of genetic engineering, I think they will find a way to grow “human” kidneys, at least “human” for our immune system’s standpoint, in animals (likely pigs). I’ve even heard of clinical trials starting within the next few years. But for now, we are stuck with a very limited supply of human organs.

Could lifestyle changes help manage some of the diseases you treat?

I think unhealthy lifestyles accelerate the disease process. The No. 1 reason for dialysis in the country today is diabetes. And while lifestyle choices play into the disease, I think there is clearly a genetic disposition. You can see this with kidney transplants. If you take a kidney from an African-American donor and put it in a Caucasian patient, usually that kidney will do more poorly than a kidney donated from a Caucasian, suggesting there is something other than lifestyle or socioeconomics at work.

Interestingly recent studies suggest that just as sickle cell disease carriers are protected against malaria, African Americans may be at higher risk of kidney disease due to a similar genetic predisposition that initially protected them against sleeping sickness.

Did your family relocate to Casper with you?

My wife, Leslie, made the move with me. However my children are now out of the house. One is an ICU nurse in Houston and the other is a pre-med student at Virginia Tech.

How does your wife like it so far?

She likes the cold, so she was thrilled to move here from hot humid Virginia Beach.

As an internist and nephrologist with the Office of Attending Physician of Congress, Dr. Eric Sawyers provided care to 16 United States Senators and 75 Congressmen on 15 separate missions to 65 countries, including missions to North Korea, Libya and four different war zones. During Operation Iraqi Freedom, he performed the first U.S. military combat-related dialysis since the Vietnam War. He is a graduate of the United States Naval Academy and the Uniformed Services University of the Health Services in Bethesda, Md.